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PubMedDate not supplied

Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy.

BACKGROUND CONTEXT: Laminoplasty has been reported to achieve good operative results for treatment of cervical stenotic myelopathy. However, long-term results and prognostic factors have not been well documented. Among postoperative complications, weakness of the shoulder girdle muscles has been reported as a particular complication of laminoplasty, but the cause is still poorly understood. PURPOSE: Our aim was to clarify the short-term complications and long-term operative results after unilateral open-door laminoplasty and to identify the predictors for operative outcome. STUDY DESIGN: We retrospectively reviewed short-term complications and long-term operative results associated with cervical stenotic myelopathy treated by unilateral open-door laminoplasty. PATIENT SAMPLE: There were 162 men and 42 women with an average age of 57 years who were treated by unilateral open-door laminoplasty in the two institutions. Pathogenesis of myelopathy was cervical spondylosis in 88 patients, cervical disk herniation with a narrow spinal canal in 10, and ossification of the posterior longitudinal ligament in 106. OUTCOME MEASURES: Postoperative complications and their outcomes were examined clinically in 204 patients, and causes of motor paresis were sought with postoperative computed tomography after myelography. Postoperative improvement of clinical symptoms was assessed by recovery rate calculated with the scores of the Japanese Orthopaedic Scoring System in 80 patients. METHODS: The occurrence rate of short-term postoperative complications, causes of motor paresis, and their outcomes were reviewed in 204 patients. Clinical condition was assessed with the Japanese Orthopaedic Scoring System, recovery rate was calculated with the score, and prognostic factors for outcome were studied in 80 patients who were followed up for 5 years or longer (average, 8 years; range, 5-17 years). RESULTS: Occurrence rate of complications, such as muscle weakness, deep infection, closure of opened laminae, and others, was 10.8%. Muscle weakness was observed in 7.8% of the patients. However, this rate decreased in recent years. The cause of motor paresis is not known with certainty, but it may be secondary to operative trauma, posterior shift of the spinal cord, or to displacement of the lamina in the hinge side. Recovery rate of clinical symptoms was 62.1% at the final follow-up. Rates were 63.6% for cervical spondylosis, 87.1% for cervical disk herniation, and 61.3% for ossification of the posterior longitudinal ligament. There was no significant difference between pathologies. Patient age younger than 60 years at the time of operation and less than 1 year's duration of symptoms before surgery were significantly associated with recovery rate of clinical symptoms. Recovery rate was not correlated with either preoperative function judged by the Japanese Orthopaedic Association score or spinal sagittal diameter. CONCLUSIONS: The main cause of postoperative motor paresis of upper extremities is thought to be operative trauma, resulting from such procedures as air-drill and Kerrison rongeur handling. Short-term complications may decrease with the use of nontraumatic procedures. Better operative outcomes may be achieved with careful operative procedures and early operative treatment in the patients with myelopathy.

Adolescent↗
PubMed1984

Specimen radiography of bone tumours.

Radiographs obtained with a transportable roentgen apparatus and a shielded cabinet on fine grain films of whole specimens and/or slabs of transsected bone in primary bone tumours and soft tissue tumours with skeletal invasion or ossification were compared with clinical roentgenograms and related to gross and microscopic pathology as demonstrated in selected cases. Specimen radiography is found to be a valuable adjunct to standard morphologic examination and forms a link to clinical radiology in the study of bone tumours and related diseases.

Adolescent↗
PubMed2004

[Morphofunctional changes of coccyx area in posttraumatic coccygodynia].

For definition of a pathogenesis ofposttraumatic coccygodynia, a study of morpho-functional changes of the structures of coccyx's area was organized. The preparations of coccyx, removed during operative intervention from 23 different-aged patients with manifestations of disease were analyzed by roentgen, histological technique and a submicroscopy. In a cartilaginous tissue from patients with posttraumatic coccygodynia, dystrophic changes of chondrocytes down to their atrophy, a destruction of the basic material with partial replacement of a fibrillar cartilaginous tissue with a hyaline cartilage were observed with a different degree of manifestation. Vessels and sacrococcygeal nervous plexus were subjected to pathological changes. Increased post-traumatic mobility, alterations in the process of ossification, deceleration of physiological joining of coccyx vertebras and sacrococcygeal joint alter biomechanical properties of coccyx at sitting. These alterations lead to the long-lasting traumatization with degenerative - dystrophic changes, reinforcement of pain syndrome and manifestation of dysfunctions of organs of pelvis.

Adolescent↗
PubMed1998

Apparent primary ossification of the menisci in a dog.

A 2-year-old Collie was examined after it developed acute lameness in the right hind limb. Palpation of the right stifle elicited signs of pain, but a cranial drawer sign could not be elicited during palpation of the joint. Radiography revealed mineralized opacities in the craniolateral and caudal portions of the right stifle joint. Exploratory arthrotomy of the right stifle joint revealed a firm mass in the cranial horn of the lateral meniscus, which was characterized as osseous metaplasia in the cranial and caudal menisceal horns on histologic examination. Other abnormalities were not identified during surgery. Results of histologic examination, radiologic evidence, and observations during exploratory surgery supported a diagnosis of primary lateral meniscal ossification of the right stifle joint. Radiographs were obtained of the contralateral stifle joint when the dog was clinically normal (5 weeks after arthrotomy), and mineralized opacities were found in the lateral meniscus of this limb as well. Clinical signs may not be associated with primary intrameniscal ossification initially; type and location of ossification may affect likelihood and severity of clinical signs and secondary joint damage. Initial treatment for menisceal ossification is conservative (anti-inflammatory medications) unless there is a concurrent pathologic process that requires surgical repair.

Animals↗
PubMed1975

Cataracta ossea and other intraocular ossifications. A case report and a thirty-year Danish material.

Cataracta ossea is described in a 5-year-old Danish boy, representing a sequal to a unilateral measles-endophthalmitis 3 years earlier. Ossification was not demonstrated elsewhere in the eye. Further, cases of intraocular ossification over a 30-year period were reviewed, based on the files of the Eye Pathology Institute. The total of 155 made up about 3% of enucleated eyes from Danish material received for examination. Regarding age at the initial eye lesion, more than half appeared within the first decade of life. The most frequent underlying lesions were trauma (32%) and uveitis (25%). Among the less frequent causes, emphasis is given to three cases of malignant uveal melanoma. Ossification of the lens was not encountered in the series - except for the case which motivated the review.

Cataract↗
PubMed1991

Prolonged gestation in a Holstein cow: adenohypophyseal aplasia and skeletal pathology in the offspring.

A Holstein fetus was delivered by Caesarean section at a gestational age of 441 days. The pituitary pars distalis was aplastic and the adrenal and thyroid glands were severely hypoplastic. Arrested or retarded cartilage cell maturation resulted in absence or minimal development of epiphyseal ossification centers, delayed ossification of carpal bones, and arrest of longitudinal growth of bones. The pathophysiology of prolonged gestation and of skeletal pathology is discussed.

Adrenal Glands↗
PubMed1996

Avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissue.

Patients who have sustained an avulsion fracture and present clinically during the healing phase of the injury may manifest a mass that clinically and radiographically mimics a malignant neoplasm. A 15-year-old male soccer goalkeeper presented with a large ossified mass in the soft tissues overlying the right hip 6 months after experiencing a popping sensation in his hip joint during a game. Although an osteosarcoma was suspected clinically and radiographically, a Tru-Cut needle biopsy of the lesion revealed reactive bone formation. Correlation of the clinical, radiographic, and pathologic findings indicated an avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissues. The healing phase of an avulsion fracture may clinically and radiographically be mistaken for neoplasia. In such cases, a Tru-Cut needle biopsy may reveal the reactive nature of the process.

Adolescent↗
PubMed1993

Epiphysial ossification centres in iliosacral joints: anatomy and computed tomography.

Bilateral apparently bony structures of different forms and sizes located in the inferior and superior ventral parts of the sacroiliac joints were observed on axial CT images of the pelvic region of juvenile patients. No other pathological changes were noted in the sacroiliac joints of these individuals. In one patient the bony structures could also be seen on a conventional plain radiograph. We also examined 3 juvenile autopsy specimens of this joint using radiology, CT, macroscopical evaluation and histology. In two of them, structures could be detected on the CT scans which were similar to those observed in the young patients. Macroscopic investigations revealed the structures to be secondary ossification centres located in the articular cartilage of the lateral part of the os sacrum at the levels of the first and third sacral segments. According to older anatomical literature, these epiphysial ossification centres contribute to the auricular surface of the lateral part of the os sacrum and the free lateral surface of the inferior sacral parts. They can be observed between the ages of 12 and 25 years and begin to synostose with the lateral part around the age of 18 years. In macerated juvenile specimens of the bony pelvis, free ossicles were not detectable in the region of the sacroiliac joints. Histological peculiarities of the ossification process observed are discussed. These physiologically occurring ossification centres are to be differentiated from pathological alterations appearing as bony or bone-like structures on CT scans.

Adolescent↗
PubMed1980

Pseudo-tumoral ossification of the muscles and/or periosteum. (A study of 57 cases).

The authors present a study of fifty-seven cases of pseudo-tumoral ossification of the muscles ("circumscribed ossifying myositis") and of the periosteum, supported by clinical, radiographic and histological evidence. This pathological condition is characterised by the formation of hyperplastic bone callus in muscle or periosteum, with a typical radiographic appearance, and with a relationship to trauma. We have excluded from our study pseudo-tumoral periosteal ossification in conditions of congenital origin (osteogenesis imperfecta, neurofibromatosis, Sane et al., 1971; Kullman et al., 1972), hyperplastic fracture callus in cranial trauma, ossification of muscles in limbs which are paretic or paralysed due to cerebral or cord lesions, and hyperplastic fracture callus in congenital syphilis. The form which is the subject of this study is absolutely benign, develops over a period of twelve to twenty-four months, with spontaneous maturation and partial regression. It can abe treated by radiotherapy to accelerate maturation, or by surgery when maturation has been completed.

Adolescent↗
PubMed2002

Mechanism of destructive pathologic changes in the spinal cord under chronic mechanical compression.

STUDY DESIGN: A histologic and histochemical study was performed both in the autopsy of a human patient with cervical spinal cord compression caused by ossification of the posterior longitudinal ligament and in a tiptoe-walking Yoshimura mouse model of progressive cervical cord compression. OBJECTIVES: To clarify the mechanism of destructive pathologic changes in the spinal cord under chronic mechanical compression. SUMMARY OF BACKGROUND DATA: Under chronic compression, the spinal cord exhibits destructive changes considered to be causes of profound and irreversible motor paresis. Recently, some investigators have found that apoptosis in acute spinal cord injury induces both secondary degeneration at the site of injury and chronic demyelination of tracts away from the site of injury. However, the mechanism responsible for these destructive spinal cord changes under chronic compression remains unclear. METHODS: The spinal cord was examined histologically, and an attempt was made to detect apoptotic cells using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling in both the autopsy of a human patient and tiptoe-walking mice exhibiting spinal cord compression. RESULTS: Apoptotic cells were observed in the chronically compressed spinal cord in both the autopsy of a human patient and model mice. In tiptoe-walking mice exhibiting spinal cord compression, descending degeneration in the anterior and lateral columns and ascending degeneration in the posterior column were observed. The distribution of oligodendrocytes with positive results from terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling was similar to that for degeneration of the long tracts. CONCLUSIONS: Spinal cord cell apoptosis may produce destructive changes in the spinal cord under chronic compression, with a resulting irreversible neurologic deficit.

Aged↗
PubMed1998

Prenatal ultrasonographic description and postnatal pathological findings in atelosteogenesis type 1.

Atelosteogenesis type 1 (AO1) is a rare lethal chondrodysplasia characterized by incomplete ossification of cartilage anlagen. Histologically, the cartilage contains irregular clusters that occasionally include giant chondrocytes. Pulmonary hypoplasia is a characteristic finding that has been presumed to be the cause of neonatal lethality. We report on a male fetus with AO1 and document the early ultrasonographic/ radiologic progression of this disorder from 15 weeks gestation until delivery at 41 weeks. While the radiological findings we describe are typical of AO1 by the lack of proximal and middle phalangeal ossification, the complete radiological picture showed considerable overlap with boomerang dysplasia. Although pulmonary hypoplasia was present, it was moderate and considered unlikely to be the sole cause of death. Detailed neonatal and postmortem examination showed severe subglottic hypoplasia and tracheomalacia. The tracheal walls were supported by thin and pliable cartilaginous plates that allowed luminal collapse with minimal pressure. The marked luminal narrowing, tracheomalacia, and temporal proximity of extubation to demise support tracheal collapse as a major contributor to the death in AO1. The detailed description of this patient should contribute to earlier diagnosis of this condition; anticipation of the poor prognosis in AO1 is essential for appropriate genetic counseling of the parents and for determining postnatal treatment options.

Abnormalities, Multiple↗
PubMed1989

[The clinical x-ray picture and treatment of the hemimelic form of epiphyseal dysplasia].

The authors have studied the course and the efficacy of the surgical treatment of the hemimelic form of epiphyseal dysplasia in 15 children. Three roentgenologic types of epiphysis lesions have been distinguished. It has been determined that the pathologic changes are mainly localized in the posterior medial departments. In multiple severe lesions hyperfunction of the growth areas followed by their early asymmetric synostosis with the development of secondary deformations and focal disturbances in the ossification of the metaphyses have been observed. The necessity of early surgical treatment allowing to prevent the development of the pathologic changes in the growth areas and deforming arthrosis has been substantiated.

Child↗
PubMed2005

Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation.

Twenty-two patients with subaxial acute traumatic central cord syndrome (CCS) without fracture or dislocation who underwent surgery between 1995 and 2002 were reviewed, retrospectively. There were 13 males and nine females ranging in age from 24 to 84 years (mean 61.2). Falls were the most common injury (68%), followed by motor vehicle accidents (32%). All patients had dynamic cervical lateral radiographs and magnetic resonance imaging (MRI). Cord compression was present in all cases and cervical instability in 11. Associated pathology included disc herniation in seven patients, cervical spondylosis (CS) in 11 and ossification of the posterior longitudinal ligament (OPLL) in four. Anterior decompression and fusion was performed in 12 patients with 1- or 2-level lesions. Posterior decompression and fusion was performed for multilevel lesions in 11 patients, including one patient who required re-operation. The interval between injury and surgery ranged from 1 to 37 days (mean 8.0). Postoperatively, all patients improved clinically. We conclude that surgical management of subaxial acute traumatic CCS without fracture or dislocation improved neurological status and prevented delayed neurological deterioration in our patients.

Adult↗
PubMed1992

Anterior maxillary supernumerary teeth: a clinical and radiographic study.

Clinical records and radiographs of 90 patients with 113 anterior maxillary supernumerary teeth (mesiodens) have been evaluated. Although uncommon, mesiodentes are the most frequent supernumerary teeth and may disturb the eruption and/or position of the adjacent permanent incisors. Clinical and radiographic examination may disclose the number, direction and location of mesiodentes and their effects on neighbouring teeth. In the present study the majority of the supernumerary teeth lay palatal to the central incisors. Complete or partial eruption of a mesiodens was rare, hence the importance of radiographs to locate supernumerary teeth in the premaxilla. Pathological findings included the formation of dentigerous cysts in three patients and complete ossification of the pericoronal space with resorption of the crown of the mesiodentes in eight cases. Retention and malposition of the adjacent permanent incisors occurred in 39 and 24 cases, respectively.

Adult↗
PubMed1980

Primary hypertrophic osteoarthropathy (PHO) and changes in the joints. Clinical, X-ray, scintigraphic, arteriographic and histologic examination of 19 patients.

Nineteen patients with PHO with onset in childhood are presented. In 7 cases the syndrome was found in other family members too. In clinical, X-ray scintigraphic, arteriographic, and plethysmographic investigations, joint affection was found in 14 patients. Clubbing of the fingers and toes was seen in all the patients and a periosteal reaction was found in the long bones in 11 patients. Arteriography was carried out in 5 patients and showed hypervascularization and arteriovenous anastomoses in the clubbed fingers. The gas analysis of the arterial blood did not show any pathological changes. The histological finding showed poorly vascularized and oedematous periarticular tissue and ossification in the periosteal area, while in the synovial membrane, slight, nonspecific inflammatory changes were seen.

Adult↗
PubMed1994

Arthroscopic resection of an extrasynovial ossifying chondroma of the infrapatellar fat pad: end-stage Hoffa's disease?

Hoffa's disease, an obscure cause of anterior knee pain resulting from impingement and inflammation of the infrapatellar fat pad, was first reported by Albert Hoffa in 1904. Since the initial description, the clinical and pathological processes with an acute-to-chronic progression have been defined. Despite reports of eventual fibrocartilaginous transformation and ossification of the fat pad, no relation has been described between chronic impingement and the development of ossifying chondroma. We present a case of a unilateral, ossifying chondroma in the infrapatellar fat pad that resulted from chronic impingement and repetitive microtrauma. This case shows the radiologic, histologic, and pathologic features of Hoffa's disease. Successful arthroscopic resection is presented. A possible relationship between impingement of the infrapatellar fat pad and the development of ossifying chondroma may exist.

Arthroscopy↗